Even as states look to expand the availability of medical marijuana and licensed physicians, a grey legal area has kept the progress slow in states like New York, which recently released a previously hidden list of prescribing cannabis doctors with the hope of easing access for patients. But despite the efforts by state officials and by medical cannabis advocates, many physicians remain very wary of the conflicting federal and state laws, encouraging doctors to remain cautious about publicly supporting medical marijuana. New York ends up being just the latest state to struggle with getting medical marijuana into the hands of patients with qualifying conditions, leaving more than half of cannabis doctors off of the voluntary public list even as the number of patients continues to swell.

Much of this pressure comes from the recent changes to New York’s medical marijuana laws, which now allows those with chronic pain to obtain prescriptions. Although this was a win for Democratic State Senator Diane Savino of Staten Island, a medical marijuana advocate, new complications have arisen thanks to the difficult access to New York’s registered cannabis prescribers. The recent move by New York State aimed to alleviate some of this difficulty, as many qualifying patients have had to rely on cold calling physicians in the hope of obtaining access. With the new voluntary list issued by the state, roughly one in three registered doctors in New York is now public about being a registered medical cannabis prescriber, which could still leave the expanding patient population with difficulty in obtaining medication.

Although there are potentially a host of factors complicating the issue, a main concern among physicians seems to be the obvious conflict between federal and state law. While enforcing marijuana laws was not seen as a priority in the Obama administration, new Attorney General Jeff Sessions, a long-time cannabis detractor, is seen as considerably more likely to enforce the standing federal laws. Even though New York doctors were cautious before 2017 as well, the new list released by New York suggests significant hesitation by prescribing physicians when it comes to publicly supporting medical cannabis. In addition to the federal versus state dynamic, health advocates like Dr. Charles Rosenberg continue to cite limited scientific data about medical cannabis as a reason for physicians to be careful about treatment.

And yet, given that two-thirds of doctors actively prescribe cannabis without being on the public list, the evidence suggests that cautious physicians are much more concerned with the law than the lack of scientific data. As the president of the Medical Society of the State of New York, Rosenberg also told reporters that he advises physicians not to get on the wrong side of federal law. For physicians with healthy practices that are not looking for legal complications, there doesn’t seem to be a great deal of incentive to join the public list at this point in time.

The grey area being worked out in New York also echoes a myriad of other legal complications that have popped up as states grapple with asserting state law against federal restrictions. In Southern California, cannabis storefronts in both Los Angeles and San Diego have dealt with a host of legal fights, including strict application of zoning laws as well as severe fines and stores closures over the last couple of years. Although officials have been able to suppress storefront ownership in Southern California by going after landlords renting to dispensaries, medical marijuana delivery has been much more difficult to affect and the state also recently voted to legalize cannabis for recreational use, further diminishing the position of anti-cannabis advocates.

Even though the progress has been slow in New York and elsewhere, State Senator Savino and others are also encouraged about the recent developments in the New York’s medical marijuana policies. Savino helped push for the public list of prescribers and backed legislation that named chronic pain as a condition for obtaining treatment, which has brought aboard more than 3,300 patients in the first couple of months since the measure was adopted. While it is likely to remain a continual back-and-forth between states and federal law, more patients than ever before in New York – and around the country – are enjoying the benefits of medical cannabis despite the problematic grey areas.

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